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Massachusetts rates for HCPCS A4391

Ostomy pouch, urinary, with extended wear barrier attached (one piece), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.32 / $4.32 / $4.32
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.32 / $4.32 / $7.48
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.65 / $28.12 / $80.00
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.86 / $6.65 / $9.64
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.74 / $6.74 / $20.02
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.24 / $7.02 / $7.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.39 / $5.93 / $7.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.04 / $5.93 / $11.63
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.43 / $4,618.00 / $9,239.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.05 / $8.05 / $8.44
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.15 / $5.15 / $5.15
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.04 / $80.00 / $80.00
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.47 / $4.93 / $9.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.76 / $4.93 / $9.64